Organization
WESTERN TIDEWATER COMMUNITY MENTAL
Active
Other names
Western Tidewater Community Services Board
Organization subpart
No
Provider details
NPI number
Authorized official
MARION YOUNG (REIMBURSEMENT SUPERVISOR)
(757) 687-9087
Entity
Organization
Contact information
Practice address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-2586
Mailing address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-2586
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
—
—
171WH0202X
Home Modifications Contractor
—
—
225CA2400X
Assistive Technology Practitioner Rehabilitation Counselor
—
—
251B00000X
Case Management Agency
084-16-001
VA
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
333300000X
Emergency Response System Companies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945310
—
VA
05
—
1689615296
—
VA
01
—
270369
ANTHEM GROUP NUMBER
VA
Enumeration date
06/08/2006
Last updated
01/23/2026
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